Provider Demographics
NPI:1811396450
Name:CONTILLO, CHELSEY (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CHELSEY
Middle Name:
Last Name:CONTILLO
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 W KOENIG LN
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78756
Mailing Address - Country:US
Mailing Address - Phone:512-480-9573
Mailing Address - Fax:512-458-9573
Practice Address - Street 1:1505 W KOENIG LN
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756
Practice Address - Country:US
Practice Address - Phone:512-480-9573
Practice Address - Fax:512-458-9573
Is Sole Proprietor?:No
Enumeration Date:2014-08-20
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107279235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX419185001Medicaid